tbuckley/cabot-search huggingface dataset:
Abstract 11629: Multicenter Development and Validation of a Machine Learning Risk Model to Predict Right Ventricular Failure Following Mechanical Circulatory Support: The STOP-RVF Score
Authors: Christos P Kyriakopoulos, Iosif Taleb, Naila Ijaz, Zachary Demertzis, Adithya Peruri, Omar Wever-Pinzon, Antigone G Koliopoulou, Michael J Bonios, Thomas C Hanff, Elizabeth Dranow, Theodoros V Giannouchos, Konstantinos Sideris, Marisca Nelson, Ashley Elmer, Daniel Tang, Hassan Nemeh, Josef Stehlik, James C Fang, Craig H Selzman, Rami Alharethi, William Caine, Jennifer Cowger, Palak Shah, Stavros G Drakos
Journal: Circulation (2022)

Introduction: Existing models predicting right ventricular failure (RVF) after durable left ventricular assist device (LVAD) support are limited due to lack of multicenter validation, absence of intraoperative characteristics, and marginal predictive power. We sought to derive and validate a risk model to predict post-LVAD RVF. Methods: Advanced heart failure (HF) patients (N=798) requiring continuous-flow LVAD were enrolled at the Utah Transplant Affiliated Hospitals (n=477), Inova Heart &amp; Vascular Institute (n=183), and Henry Ford Medical Center (n=138). Baseline clinical and intraoperative characteristics were recorded. The primary outcome was RVF incidence, defined as the need for right VAD (RVAD) or intravenous inotropes for &gt;14 days. Bootstrap imputation and lasso variable selection were used to derive a predictive model which was then validated. A risk calculator was developed classifying patients into risk groups, and survival was compared. Results: Patients were predominantly white (72%), males (84%), aged 56±13 years. Patients in the RVF and non-RVF groups were comparable in terms of sex, age, and LVAD indication, while RVF patients more commonly had a history of systemic hypertension, non-ischemic cardiomyopathy, lower INTERMACS profiles, and more commonly required inotropic or temporary circulatory support pre-LVAD. Overall, 193 (24.2%) patients developed RVF with 109 (56.5%) requiring inotropes and 84 (43.5%) an RVAD. Multivariable predictors for RVF are shown in the Figure and achieved a c-statistic of 0.74 (95% CI: 0.70-0.78). Inclusion of intraoperative characteristics did not improve model performance. Cumulative survival was higher in the minimal risk group compared to low, moderate, and high. Conclusions: The STOP-RVF calculator effectively stratifies the risk for RVF after LVAD support by implementing routinely collected clinical data. It could impact patient selection and peri-operative management of advanced HF patients.
Abstract 11426: Processes and Outcomes for 121,576 Patients With ST Elevation Myocardial Infarction in the AHA Get With the Guidelines®-Coronary Artery Disease (GWTG-CAD) Registry, 2018-2021
Authors: James G Jollis, Jacqueline E Tamis-Holland, Abhinav Goyal, Timothy D Henry, Jessica K Zegre-Hemsey, William J French, Murtuza J Ali, Harper Stone, Mayme L Roettig, Ram Poudel, Christopher B Granger, Alice K Jacobs
Journal: Circulation (2022)

Introduction: Timely treatment of ST elevation myocardial infarction [STEMI] requires ongoing coordinated care between emergency departments, paramedics, and primary percutaneous coronary (PCI) intervention facilities. Methods: To provide a current view and a national benchmark, we examined 121,576 patient records submitted by 648 hospitals participating the GWTG-CAD registry from Q2 2018 through Q3 2021 [median age 63, women 29%, Black 11%, Hispanic 8%, admission cardiac arrest 5%, shock 7%, heart failure 7%, Covid 0.2%, presentation EMS 47%, walk in 27%, transfer 22%] Results: Reperfusion method for all patients included primary PCI 87%, fibrinolysis 5%, and no reperfusion 8% [increasing from 7 to 9% during the study period]. Median time from symptom onset to reperfusion was shortest for EMS patients 148 minutes, followed by walk-in 195 minutes, ground transferred 238 minutes, and air transferred 247 minutes. Process times did not improve during the study period. First medical contact to device times increased by 5 minutes for EMS and ground transferred patients in Q2 2020 corresponding with the pandemic onset, and adjusted mortality was significantly higher in the final 3 quarters compared to Q2 2018 [OR, 95% CI 1.28(1.07-1.53); 1.35(1.13-1.61); 1.23(1.03-1.48)]. Patients treated within guideline goals had significantly lower mortality [Figure]. Conclusions: These data reaffirm the association between process times and lower mortality for STEMI patients. They also identify concerning trends and opportunities for improved care. Increasing delays in treatment, particularly for hospital transfer, greater numbers of untreated patients, and increased risk-adjusted in-hospital mortality all provide strong impetus for renewed focus on STEMI systems. Regional collaborative efforts led by coordinators and informed by a common data system have the potential to reverse these trends and improve survival.
Abstract 11307: Longer Outflow Tract Conduction Time by Magnetocardiography as a Novel Non-Invasive Maker for Predicting Lethal Events in Patients With Brugada Syndrome Without Ventricular Fibrillation
Authors: Takeshi Aiba, Satoshi Nagase, Yuko Y Inoue, Tsukasa Kamakura, Yuichiro Miyazaki, Akinori Wakamiya, Keiko Shimamoto, Nobuhiko Ueda, Kenzaburo Nakajima, Mitsuru Wada, kohei ishibashi, Koji Miyamoto, Hiroshi Takaki, Shiro Kamakura, Kengo Kusano
Journal: Circulation (2022)

Introduction: Many of the Brugada syndrome (BrS) patients have no symptom or only syncope without ventricular fibrillation (VF)/sudden cardiac death (SCD), thus to whom we should recommend implantable cardioverter defibrillator (ICD) for primary prevention of SCD is still the biggest concern in the BrS. Here we investigated whether a high spatial resolution magnetocardiography (MCG) could predict lethal events of the BrS without history of VF/SCD. Methods: This study retrospectively enrolled 157 BrS patients without VF or cardiopulmonary arrest (CPA) (150 male, 42±13 years old, 118 spontaneous and 39 drug-induced type-1 ECG). Outflow tract conduction time (OT-CT) from 2-D current map of MCG was measured in all patients as well as the standard 12-lead ECG and signal-averaged ECG (SAECG). Programmed electrical stimulation (PES) for VF induction was performed in 47 patients. Results: Patients with spontaneous type-1 ECG had longer OT-CT compared with type-2 BrS patients. Na channel blocker, pilsicainide (25-50mg) unmasked type-1 ECG as well as increased OT-CT (54±18 to 127±62 ms; p&lt;0.05), whereas additional isoproterenol (1ug/kg/min) reversed the pilsicainide-induced delayed OT-CT, thus normalized the ST elevation of ECG. During follow-up (mean 72 [6-147] months), 10 (6%) patients suffered VF/CPA, and those had a higher incidence of previous syncope (50% vs. 14.4%, p=0.01) and longer baseline OT-CT (83±31ms vs. 55±24ms, p=0.01) compared with event-free patients. Receiver operating curve (ROC) revealed OT-CT=65ms was a cut-off value of VF/CPA (AUC=0.78), whereas, spontaneous type-1 ECG, late potential of SAECG, family history, and VF inducibility by PES were not associated with VF/CPA events during follow-up. Multivariate Cox proportional analysis revealed that previous syncope (HR=1.70, 95%CI:1.01-3.05, p=0.04) and OT-CT≥65ms (HR=1.72, 95%CI=1.16-2.62) were the independent predictor for lethal events in the BrS without VF/CPA. Among asymptomatic BrS patients (n=131), OT-CT≥65ms was also an independent predictor for VF/CPA (HR=1.69, 95%CI=1.04-2.79, p=0.03). Conclusion: Longer OT-CT in the MCG may noninvasively demonstrate substrate of VF in BrS and stratify the risk of lethal events in patients with BrS without history of VF or CPA.
Abstract 11698: Family History of Atherosclerotic Cardiovascular Disease and Subclinical Coronary Atherosclerosis Among Asymptomatic Individuals: The Miami Heart Study at Baptist Health South Florida
Authors: Jaideep Patel, Mahmoud Al Rifai, Miguel Cainzos Achirica, Theodore Feldman, Michael J Blaha, Michael D Shapiro, Ron Blankstein, Garima Sharma, Shozab S Ali, Lara Arias, Anshul Saxena, David Feldman, Ricardo C Cury, Matthew Budoff, Jonathan Fialkow, Khurram Nasir
Journal: Circulation (2022)

Introduction: We sought to examine whether a positive family history of coronary heart disease and/or stroke (FamHx) is associated with presence of subclinical coronary atherosclerosis, as evaluated using CAC and CCTA, in asymptomatic individuals. We also evaluated whether these associations differ by FamHx type. Hypothesis: Coronary atherosclerotic plaque burden by CCTA and baseline CAC score will differ depending on the FamHx domain assessed. Methods: We included 2,359 asymptomatic participants free from known ASCVD from the Miami Heart Study, an ongoing, community-based, prospective cohort study where all participants underwent CAC, CCTA, and FHx assessment at baseline. Self-reported FamHx in first-degree relatives was evaluated using 5 definitions: any, premature, parental, sibling, and both parents and siblings. We used multivariable logistic regression models to estimate adjusted the associations between each FamHx definition, CAC&gt;0, and presence of any coronary plaque on CCTA. Results: A total of 546 (23%) participants reported any FamHx (mean age 53.5 +/- 6.8 years, 54% female, 45% with CAC &gt;0, and 50% with any coronary plaque). In analyses adjusted for sociodemographics, any FamHx was associated with CAC&gt;0, and FamHx of both parents and siblings showed the strongest association with CAC&gt;0 (OR 2.17; 95% CI 1.01, 4.67), followed by premature FamHx ( Table ). The associations for any and parental FamHx remained statistically significant after further adjusting for traditional risk factors, while the other definitions trended in the same direction, but the confidence intervals included the null value. Associations with any plaque on CCTA were weaker than for CAC&gt;0, and none was statistically significant. Conclusion: FamHx, particularly a FamHx in both parents and siblings and premature FamHx, is associated with presence of CAC&gt;0. The number of participants with several definitions of FHx was low, likely limiting statistical power.
Abstract 11123: Effects of Home-Based Ischemic Leg Symptom-Inducing Exercise on Simultaneous Improvement in Treadmill Walking Distance and Patient Reported Outcomes and in Peripheral Artery Disease: The LITE Randomized Clinical Trial
Authors: Mary O Whipple, Bonnie Spring, Diane J Treat-Jacobson, Tamar S Polonsky, Jack Guralnik, Daniel E Forman, Dongxue Zhang, Shujun Xu, Christiaan Leeuwenburgh, Todd Manini, W. Jack Rejeski, Mary M McDermott
Journal: Circulation (2022)

Introduction: An optimal exercise intervention for individuals with peripheral artery disease (PAD) should improve both objective measures of walking and patient reported outcomes (PROs). This study evaluated whether home-based walking exercise conducted at a pace that induced ischemic leg symptoms (high intensity) improved both treadmill walking distance and related PROs more often than walking exercise conducted at a pace that did not induce ischemic leg symptoms (low intensity) and a non-exercise control group (control), respectively. Methods: Post-hoc analysis of PAD patients who participated in the 12-month LITE Trial and were assessed at 12 months follow-up. The LITE Trial randomized people with PAD into home-based high intensity exercise, low intensity exercise, or control. Objective measures of walking were pain-free treadmill walking distance (PFWD) and maximal treadmill walking distance (MWD). PROs related to physical functioning consisted of Walking Impairment Questionnaire (WIQ) and the Short Form-36 (SF-36) physical function score. Participants were categorized into one of four groups at 12-month follow-up: 1) improved both treadmill outcome and PRO, 2) improved treadmill outcome but not PRO, 3) improved PRO but not treadmill outcome; and 4) improved neither treadmill outcome or PRO. Improvement was defined as follow-up score minus baseline &amp;gt0. Results: Of the 305 people with PAD randomized, 186 (61% Black, 46% female) had data for both treadmill testing and at least one PRO available at baseline and 12-month follow-up (age, sex, race). Participants randomized to high intensity exercise were significantly more likely to improve both MWD and WIQ distance and speed (Table), as well as both PFWD and WIQ speed, compared to the other groups. Conclusions: To improve both treadmill outcomes and PROs, patients with PAD should be encouraged to walk for exercise at a pace inducing ischemic leg symptoms, and not at a pace without ischemic leg symptoms.
Abstract 11335: Mitral Valve Prolapse Increases the Force Exerted on the Papillary Muscles
Authors: Antonia Van Kampen, Matthew H Park, Serguei Melnitchouk, Robert Wilkerson, Hanjay Wang, Yuanjia Zhu, Pearly Pandya, Yasufumi Nagata, Michael A Borger, Robert Levine, Y. Joseph J Woo
Journal: Circulation (2022)

Introduction: Recent studies have linked mitral valve prolapse (MVP) to localized myocardial fibrosis, ventricular arrhythmia, and even sudden cardiac death independent of mitral regurgitation (MR). The primary mechanistic theory is rooted in increased papillary muscle (PM) traction force, yet there is no biomechanical evidence to support it. Thus we aimed to evaluate the biomechanical relationship between prolapse and PM forces, leveraging advances in ex vivo simulation technology. Methods: We developed an ex vivo PM force transduction system (Fig. A, B) and a novel neochord length adjustment system (Fig. C) capable of modeling targeted prolapse without creating severe MR. Using unique models of bileaflet and posterior leaflet prolapse, we directly measured hemodynamics and forces, comparing optimally coapting (i.e., physiologic) and prolapsing valves. Results: Throughout the experiments, hemodynamics and MR severity remained comparable between the physiologic and prolapse conditions. We found that bileaflet prolapse in this experimental setting increases PM forces by 5-15% (p&lt;0.001) compared to a physiologic valve. We furthermore observed fundamental differences in the force profiles for prolapsing valves with higher primary peaks (Fig. D) . In the isolated posterior leaflet prolapse condition, prolapsing valves had significantly higher primary peak forces ( p=0.044 ), with a strong trend towards higher overall PM force magnitudes (p=0.051 ), when compared to physiologic valves. Conclusions: Through advances in ex vivo heart simulation technology, we discovered that bileaflet prolapse, with MR similar to the physiologic valve, results in significantly elevated forces and altered dynamics on the PMs. Our work carries deeper implications, suggesting that interventions might reduce abnormal PM forces (and subsequent ventricular effects of MVP) in addition to MR correction, with possible benefit even in less-than-severe MR.
Abstract 11224: Anatomical Characteristics of Myocardial Bridging and Its Impact on Myocardial Ischemia in Patients With Nonobstructive Coronary Artery Disease
Authors: Takumi Toya, Naganuma Tsukasa, Suzue Hara, Miyuzu Ichishima, Yuji Nagatomo, Takeshi Adachi
Journal: Circulation (2022)

Introduction. Epicardial coronary arteries running through the myocardium (myocardial bridges: MBs) are compressed during myocardial contraction and may be involved in myocardial ischemia. However, the anatomical characteristics of MBs and their impact on myocardial ischemia have not been well characterized. Methods. We included 626 patients who underwent coronary artery computed tomography to evaluate ischemic signs and/or symptoms (mean age 66±13 years, 32% males). Curved multiplanar reformation images were used to assess MBs' presence, length, and thickness. In patients with positive noninvasive stress testing (NST), we compared the frequency and anatomical characteristics of MBs between patients with obstructive coronary arteries (OCA defined as &gt;50% stenosis in main branches) and those with nonobstructive coronary arteries (INOCA). Results. MBs were found in 176 patients (28%), of which 45% were superficial (≤2 mm), 54% were deep (2-5 mm), and 1% were very deep (&gt;5 mm) MBs (mean MB thickness 2.2±0.9 mm). The mean MB length was 18.2±5.7 mm with 14% long MBs (≥25 mm). Ninety-four out of 202 patients undergoing NST presented positive results, 62 of whom had OCA and 32 had INOCA. MBs were more frequently observed in patients with INOCA than in those with OCA (63% vs. 39%, P=0.03) (Figure A). Interestingly, INOCA patients tended to have longer MBs than those with OCA (20.7±6.0 mm vs. 17.6±5.4 mm, P=0.08), whereas MB thickness was not different between the two groups (2.3±0.7 vs. 2.0±0.6, P=0.19) (Figure B). Conclusion. Longer MBs may significantly impact myocardial perfusion, potentially producing positive results on stress tests in patients with INOCA.
Abstract 11378: Spontaneous Esophageal Hematoma in Chronically Anticoagulated Atrial Fibrillation
Authors: Manasa Jasti, Ammu Thampi Susheela MD, Alejandro Rana Custodio, Amit Srivastava, David Cusick
Journal: Circulation (2022)

Introduction: Intramural esophageal hematoma is a rare condition presenting with dysphagia, nausea and mid epigastric or retrosternal chest pain. We present a unique case of spontaneous esophageal hematoma in a patient anticoagulated with apixaban for atrial fibrillation. Case presentation: An 88-year-old woman with history of hypertension, hypothyroidism, persistent atrial fibrillation on apixaban presented to emergency department with sudden onset epigastric pain, dysphagia and nausea without vomiting while having dinner. Physical examination was unremarkable except for mild tenderness in the epigastric region. Initial workup including complete blood count, complete metabolic panel, lipase, troponin was unremarkable. EKG showed atrial fibrillation with no ischemic changes. CT chest showed abnormal hyperdense mass-like thickening approximately 4 x 3 x 12 cm involving the mid/distal thoracic esophagus with possible differentials being food bolus, esophageal hematoma or mass. Prothrombin complex concentrate (Kcentra) was given as patient was on apixaban and gastroenterology was consulted for upper endoscopy which showed a large hematoma occupying most of the esophageal lumen at the entire length of esophagus. After family discussion on stroke-versus-bleeding risk with anticoagulation, cardiology recommended holding anticoagulation for at least a month and future evaluation for WATCHMAN device. With stable hemoglobin and gradual advancement to a soft diet, patient was discharged home with repeat endoscopy planned in two weeks. Conclusion: Spontaneous esophageal hematoma, although rare in incidence, should be identified as a differential diagnosis in a patient on anticoagulation presenting with chest pain. Literature shows a higher incidence of this complication in women. Timely diagnosis and management along with discontinuing anticoagulation can significantly lower morbidity and mortality and overall has favorable prognosis.
Abstract 11667: Physical Activity and Nutrition Self-Efficacy Associates With Self-Reported Cardiovascular Health Behaviors in African Americans: The Washington, DC Cardiovascular Health, and Needs Assessment
Authors: Foster Osei Baah, Colby Ayers, Valerie Mitchell, Billy Collins, Gwenyth Wallen, Tiffany M Powell-Wiley
Journal: Circulation (2022)

Background: Increased self-efficacy may improve health behavior, but little is known about the relationship between physical activity (PA) and nutrition self-efficacy and cardiovascular health behaviors associated with weight loss among African Americans (AAs). Methods: Examined the associations between PA and nutrition self-efficacy and self-reported PA and nutrition behaviors using AA data from the Washington DC CV Health and Needs Assessment, a community-based participatory research study. All completed the PA and Nutrition Self-Efficacy (PANSE) scale with sub-scores measuring participants’ self-efficacy for engaging in PA and nutrition behaviors (higher scores= greater self-efficacy). PA types (moderate-leisure PA, vigorous-leisure PA, and strength training) and dietary (red meat, fast foods, sodas, and vegetables) behavior scores were calculated using the International Physical Activity Questionnaire (IPAQ) for self-report PA or the National Health and Nutrition Examination Survey (NHANES) dietary screener for consumption of specific food products. Linear regression models were used to assess the associations between PANSE sub-scores and corresponding PA or dietary behavior adjusting for covariates. Results: Participants (N=117) were predominantly women (82.1%), mean age=59.4 (SD±12.3) years with mean BMI 32.6 (SD±7.0) kg/m2. While PA self-efficacy remained significantly and positively associated with self-reported moderate leisure PA and strength training, nutrition self-efficacy remained significantly and negatively associated with consumption of fast foods and sodas after adjusting for covariates (Table 1). Conclusion: PA and nutrition self-efficacy are associated with self-reported PA and nutrition behaviors among AAs. Interventions that augment self-efficacy may be particularly important in improving cardiovascular health behaviors by enhancing PA and nutrition behaviors aimed at weight loss among AAs.
Abstract 11112: Frailty is Associated With Increased Mid-Term Mortality After Cabg, Independent of Age: A Nationwide Analysis of the Veteran Affairs Data
Authors: Salil Deo, Ajar Kochar, Brian Charest, Fanny Petermann-Rocha, Yakov Elgudin, Danny Chu, Robert W Yeh, Sunil V Rao, Dae Hyun Kim, Jane Driver, Daniel Hall, Ariela R Orkaby
Journal: Circulation (2022)

Introduction: Guidelines recommend considering patient age when choosing coronary revascularization strategies. However, compared with pre-operative frailty, chronologic age provides limited insight into perioperative risk as the population ages. Hypothesis: In Veterans, pre-operative frailty, independent of age, will influence 5-year mortality after coronary artery bypass grafting surgery (CABG). Methods: Using the validated VA frailty index (VA-FI), we grouped patients into non-frail (0 - 0.1), pre-frail (&gt;0.1 - 0.2), and frail (&gt;0.2) categories. To determine the association between frailty categories and 5-year mortality we fit a multi-level adjusted Cox proportional hazards model using non-frail patients as the referent. We obtained days in hospital (DIH) in the first postoperative year for all groups and compared results with the Wilcoxon test. Results: Among 13,554 patients (2016 - 2020) who underwent CABG (mean age 67 years; 98.5% males, 79% white), 54% 36% and 22% had diabetes mellitus, chronic kidney disease and heart failure respectively. The mean pre-operative VA-FI was 0.21(0.1); 31% were pre-frail and 47% were frail. Frailty prevalence was highest in those &lt;60 years (741/1,416 (52%) compared with 60 - 80 years (2,151/8,735 (25%)) and &gt;80 (79/511 (15%)). The 5-year mortality rate (per 1000 patient-years) was higher in frail patients [54.4 (51.4, 57.7); HR (95% CI) 1.75 (1.54,2.00)] and pre-frail [35 (32.1, 38.3); HR 1.2 (1.08,1.34)] than non-frail patients [27.1 (24, 30.6)]. Compared with non-frail patients (mean 2.7 + 11.6 days), pre-frail (3.9 + 13.9; p &lt; 0.01) and frail (6.3 + 17.6; p &lt; 0.01) spend more days in the hospital in the first post-operative year. Conclusions: Irrespective of age, frailty and pre-frailty were prevalent among US Veterans undergoing CABG and were associated with increased mortality risk and longer hospital length of stay, highlighting the need to evaluate for frailty, even among young patients.